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Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries

BACKGROUND: Two antifibrotic drugs, pirfenidone and nintedanib, are approved by the European Medicines Agency and the US Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis (IPF). In this analysis, treatment patterns of European patients with IPF were investigated to unde...

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Autores principales: Maher, Toby M., Molina-Molina, Maria, Russell, Anne-Marie, Bonella, Francesco, Jouneau, Stéphane, Ripamonti, Elena, Axmann, Judit, Vancheri, Carlo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602932/
https://www.ncbi.nlm.nih.gov/pubmed/28915874
http://dx.doi.org/10.1186/s12890-017-0468-5
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author Maher, Toby M.
Molina-Molina, Maria
Russell, Anne-Marie
Bonella, Francesco
Jouneau, Stéphane
Ripamonti, Elena
Axmann, Judit
Vancheri, Carlo
author_facet Maher, Toby M.
Molina-Molina, Maria
Russell, Anne-Marie
Bonella, Francesco
Jouneau, Stéphane
Ripamonti, Elena
Axmann, Judit
Vancheri, Carlo
author_sort Maher, Toby M.
collection PubMed
description BACKGROUND: Two antifibrotic drugs, pirfenidone and nintedanib, are approved by the European Medicines Agency and the US Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis (IPF). In this analysis, treatment patterns of European patients with IPF were investigated to understand antifibrotic prescribing and identify unmet needs in IPF treatment practice. METHODS: Between February and March 2016, respiratory physicians from France, Germany, Italy, Spain, and the UK participated in an online questionnaire designed to collect information on IPF treatment patterns in patients under their care. Patients were categorized as treated (received approved antifibrotics) or untreated (did not receive approved antifibrotics, but may have received other unapproved therapies). Classification of IPF diagnosis (confirmed/suspected) and severity (‘mild’/‘moderate’/‘severe’) for each patient was based on the individual physician’s report. Patients’ perspectives were not recorded in this study. RESULTS: In total, 290 physicians responded to the questionnaire. Overall, 54% of patients with IPF did not receive treatment with an approved antifibrotic. More patients had a confirmed IPF diagnosis in the treated (84%) versus the untreated (51%) population. Of patients with a confirmed diagnosis, 40% did not receive treatment. The treated population was younger than the untreated population (67 vs 70 years, respectively; p ≤ 0.01), with more frequent multidisciplinary team evaluation (83% vs 57%, respectively; p ≤ 0.01). A higher proportion of untreated patients had forced vital capacity > 80% at diagnosis versus treated patients. Of patients with ‘mild’ IPF, 71% did not receive an approved antifibrotic versus 41% and 60% of patients with ‘moderate’ and ‘severe’ IPF, respectively. CONCLUSIONS: Despite the availability of antifibrotic therapies, many European patients with confirmed IPF do not receive approved antifibrotic treatment. Importantly, there appears to be a reluctance to treat patients with ‘mild’ or ‘stable’ disease, and instead adopt a ‘watch and wait’ approach. More education is required to address diagnostic uncertainty, poor understanding of IPF and its treatments, and issues of treatment access. There is a need to increase physician awareness of the benefits associated with antifibrotic treatment across the spectrum of IPF severity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12890-017-0468-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-56029322017-09-20 Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries Maher, Toby M. Molina-Molina, Maria Russell, Anne-Marie Bonella, Francesco Jouneau, Stéphane Ripamonti, Elena Axmann, Judit Vancheri, Carlo BMC Pulm Med Research Article BACKGROUND: Two antifibrotic drugs, pirfenidone and nintedanib, are approved by the European Medicines Agency and the US Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis (IPF). In this analysis, treatment patterns of European patients with IPF were investigated to understand antifibrotic prescribing and identify unmet needs in IPF treatment practice. METHODS: Between February and March 2016, respiratory physicians from France, Germany, Italy, Spain, and the UK participated in an online questionnaire designed to collect information on IPF treatment patterns in patients under their care. Patients were categorized as treated (received approved antifibrotics) or untreated (did not receive approved antifibrotics, but may have received other unapproved therapies). Classification of IPF diagnosis (confirmed/suspected) and severity (‘mild’/‘moderate’/‘severe’) for each patient was based on the individual physician’s report. Patients’ perspectives were not recorded in this study. RESULTS: In total, 290 physicians responded to the questionnaire. Overall, 54% of patients with IPF did not receive treatment with an approved antifibrotic. More patients had a confirmed IPF diagnosis in the treated (84%) versus the untreated (51%) population. Of patients with a confirmed diagnosis, 40% did not receive treatment. The treated population was younger than the untreated population (67 vs 70 years, respectively; p ≤ 0.01), with more frequent multidisciplinary team evaluation (83% vs 57%, respectively; p ≤ 0.01). A higher proportion of untreated patients had forced vital capacity > 80% at diagnosis versus treated patients. Of patients with ‘mild’ IPF, 71% did not receive an approved antifibrotic versus 41% and 60% of patients with ‘moderate’ and ‘severe’ IPF, respectively. CONCLUSIONS: Despite the availability of antifibrotic therapies, many European patients with confirmed IPF do not receive approved antifibrotic treatment. Importantly, there appears to be a reluctance to treat patients with ‘mild’ or ‘stable’ disease, and instead adopt a ‘watch and wait’ approach. More education is required to address diagnostic uncertainty, poor understanding of IPF and its treatments, and issues of treatment access. There is a need to increase physician awareness of the benefits associated with antifibrotic treatment across the spectrum of IPF severity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12890-017-0468-5) contains supplementary material, which is available to authorized users. BioMed Central 2017-09-15 /pmc/articles/PMC5602932/ /pubmed/28915874 http://dx.doi.org/10.1186/s12890-017-0468-5 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Maher, Toby M.
Molina-Molina, Maria
Russell, Anne-Marie
Bonella, Francesco
Jouneau, Stéphane
Ripamonti, Elena
Axmann, Judit
Vancheri, Carlo
Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries
title Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries
title_full Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries
title_fullStr Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries
title_full_unstemmed Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries
title_short Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries
title_sort unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five european countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602932/
https://www.ncbi.nlm.nih.gov/pubmed/28915874
http://dx.doi.org/10.1186/s12890-017-0468-5
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